DEFIBRILLATOR SYSTEM CONDITION INDICTATOR

Abstract: A defibrillator (30) with an automatic self-test system (42) that includes a test signal generator and a defibrillator status indicator. The test system (42) preferably performs functional tests and calibration verification tests automatically in response to test signals generated periodically and/or in response to predetermined conditions or events and indicates the test results visually and audibly. The invention also relates to a method for automatically determining and indicating a defibrillator's status without human intervention.

Description: DEFIBRILLATOR WITH SELF-TEST FEATURES Technical Field This invention relates generally to a defibrillator system that performs periodic self-tests and, in particular, to a method and apparatus for performing periodic functional, calibration and safety tests in an automatic external defibrillator to verify that the defibrillator's components and operation are within preset specifications. Background Prior art external defibrillators were used primarily in the hospital. In that environment, the frequency with which a particular defibrillator was used was relatively high, e.g., on the order of several times per week. Periodic verification tests for these prior art defibrillators typically amounted to a battery level test and a functional test in which the defibrillator was hooked to a test load and discharged. These tests were usually performed once per day or once per shift per manufacturer recommendations. Other tests, such as recalibration of internal circuit components by a biomedical technician, were performed less often, on the order of twice per year, also pursuant to manufacturer recommendations. Each of these maintenance tests for prior art defibrillators was initiated and performed by human operators. Disclosure of the Invention While adequate for relatively frequently-used hospital-based defibrillators, prior art defibrillator test apparatuses and procedures are not optimal for use with portable defibrillators that are used less frequently. For example, defibrillators carried by emergency medical vehicles might need to be used only on a monthly basis. The burden of performing manual battery and performance tests on a daily basis could outweigh the benefits of carrying the infrequently-used defibrillator on the vehicle. The tests should therefore be performed by the defibrillator automatically. Because the tests are performed automatically, the tests should be both accurate and reliable. The portable defibrillator's mobile environment could add to the frequency of defibrillator component failure, thus increasing the need for periodic tests. In addition, portable defibrillators could be exposed to environmental conditions (such as severe vibration, sudden impacts, heat or moisture) that require an immediate reevaluation of a defibrillator's operational status. Also, the nature of the tests performed should be different in the portable defibrillator environment because of the relatively infrequent use of the defibrillators. Deterioration of system components over time could move the defibrillator out of its originally specified operating parameters. An infrequently used defibrillator should provide an operator with an indication not only of whether it will operate at all but also verify that the defibrillator meets its established specifications. Defibrillators are used in emergency situations in which time is of the essence. The operational status of a particular defibrillator as determined by the self- tests should be therefore readily apparent to an operator. Finally, there is a need for a defibrillator that can automatically recalibrate itself if certain of its system components drift from their initial values. This automatic recalibration minimizes the burden on the defibrillator's operator or maintainer and lengthens the defibrillator's useful life. This invention is a defibrillator with an automatic self-test system that includes a test signal generator and a defibrillator status indicator. The test system preferably performs functional tests and calibration verification tests automatically in response to test signals generated periodically and/or in response to predetermined conditions or events and indicates the test results visually and audibly. The invention also relates to a method for automatically determining and indicating a defibrillator's status without human intervention. The invention is described in more detail below with respect to the drawings. Brief Description of the Drawings Figure 1 is a block diagram showing a defibrillator according to this invention. Figure 2 is a schematic diagram showing a testing system of a defibrillator according to this invention. Figure 3 is a block diagram showing some of the components of a defibrillator according to a preferred embodiment of this invention. Figure 4 is a block diagram showing the system monitor of the embodiment of Figure 3. Figures 5 (a) -5(e) show various aspects of a visual display according to the embodiment of Figure 3. Figure 6 is a table showing groupings of defibrillator self-tests according to a preferred embodiment of this invention. Figure 7 is a block diagram showing the interaction of an ECG front end and a testing system according to a preferred embodiment of this invention. Figure 8 is a block diagram showing the interaction of a high voltage delivery system and a testing system according to a preferred embodiment of this invention. Figure 9 is a schematic circuit diagram of a defibrillator system according to an alternative embodiment of this invention. Figure 10 is an elevational view of an electrode system useful in the alternative embodiment of this invention. Figure 11 is an exploded view of the electrode of Figure 10. Figure 12 is a side cross-sectional view of a defibrillator electrode system according to Figures 10 and 11, prior to deployment. Figure 13 is a cross-sectional view of a connector between an electrode system and an instrument. Figure 14 is a side cross-sectional view of the defibrillator electrode system of Figure 12 with one electrode partially deployed. Figure 15 is an elevational view of a second electrode system for use with the alternative embodiment of this invention. Figure 16 is an exploded view of the electrode system of Figure 15. Figure 17 is a side cross-sectional view of the embodiment of Figure 15, prior to deployment. Figure 18 is a side cross-sectional view of the electrode system of Figure 17 with the electrodes partially deployed. Best Modes For Carrying Out The Invention This invention is a method and apparatus for automatically determining the status of a defibrillator, for displaying that status to a user or operator, and, for recalibrating certain defibrillator components. The invention is particularly useful for increasing the reliability of infrequently-used defibrillators by providing an indication of a defibrillator's operational status and by recalibrating the defibrillator, where possible, prior to any attempted use of the defibrillator. In a preferred embodiment, the defibrillator automatically generates a test signal either (1) periodically in response to the passage of time or (2) in response to a specified event or condition, such as the insertion of a new battery or a manual power-up command from an operator. The test signal initiates a plurality of preset self-tests within the defibrillator. The self- tests may include functional tests that verify the operation of certain defibrillator components and subsystems. The self-tests may also include calibration verification tests that determine whether certain defibrillator components and subsystems are operating at preset specifications or within preset specification ranges. In addition, the defibrillator may automatically recalibrate certain components or subsystems in response to a calibration verification test. No matter what test or collection of automatic self-tests the defibrillator performs, the defibrillator indicates its operational status as determined by the self-tests, such as through a visual display. The indication is preferably fail-safe so that a failure of the status indication mechanism itself will result in the indication of an inoperable defibrillator status. Figure 1 is a schematic representation of a defibrillator constructed and operated according to this invention. The defibrillator 10 includes a battery 12, a high voltage delivery system 13 (preferably consisting of a capacitor or capacitor bank 14, a capacitor charger 16 and a switching mechanism 18) , an electrode connector 20 and a controller 22 that operates the charger and switching mechanism to deliver an electric shock from the capacitor to electrodes connected to the electrode connector or interface 20. The defibrillator has a testing system 24 including a test signal generator 26 and a defibrillator status indicator 28. The purpose of testing system 24 is to test the operational status of the defibrillator's components and to provide an indication of that status automatically in response to predetermined events or conditions and/or periodically on a preset schedule. While the testing system 24 and controller 22 are shown " in Figure 1 as separate elements, they could be combined into a single element that performs all testing and operational control functions. In addition, the testing system 24 may also include components located within other defibrillator subsystems, such as within the high voltage delivery system. In any event, the testing system communicates with the tested defibrillator components and systems via communication channels to control the tests and to gather information about the status of the tested components. The testing system also communicates indicator control signals to the status indicator via communication channels as well. Figure 2 is a schematic drawing showing self- testing subsystems making up testing system 24 in the preferred embodiment. It is not necessary that a given defibrillator include each of the subsystems shown in Figure 2. According to this invention, the defibrillator must include at least one automatic self-test that is initiated in response to a test signal generated either periodically or as a result of a specified event or condition. Also, it is not necessary for the apparatus performing each test in each subsystem to be in the same physical location. Figure 2 is a logical grouping and is not intended to be an actual drawing of a defibrillator or defibrillator subsystem. Each self-test in each group of Figure 2 responds to a test initiation signal from signal generator 26, and the result of each self-test in each group affects the status is indicated on status indicator 28. This collection of self-testing subsystems may be added to or subtracted from without departing from the invention. In addition, while there may be other tests performed by the defibrillator that do not meet these criteria, such tests form no part of this invention. The first testing subsystem is the functionality tester 23. The self-tests performed by this subsystem test the operability and functionality of defibrillator components and/or subsystems. Examples include the testing of switches within the switching mechanism of the high voltage delivery system and the testing of registers within the defibrillator's controller. The second testing subsystem is the calibration verifier 25. The self-tests performed by this subsystem determine whether certain defibrillator components and/or subsystems meet preset specifications. Examples include determining the capacitance of the defibrillator's capacitor and checking the response of the controller to capacitor voltage values. The testing system also may include a recalibrator 27 that adjusts a component or subsystem of the defibrillator in response to a determination that the component or subsystem is no longer, or no longer operates, at a specified value or within a specified range of values. For example, parameters used by the defibrillator's controller to control operation of the high voltage delivery system may be changed to reflect changes in the values of defibrillator components. The actual self-tests automatically performed by a defibrillator's testing system depend in part on the defibrillator's structure and in part on reliability goals set by the defibrillator's designer. Trade-offs may be made between the completeness of a given self-test (which adds to the reliability of the defibrillator product) and the cost of implementing a complete and accurate self-test. A particular implementation of a defibrillator and its self-testing system is described below. The discussion merely illustrates a preferred embodiment of the invention. Our invention covers other defibrillator designs and other collections of defibrillator self-tests as well. Figure 3 is a block diagram showing a preferred configuration for the defibrillator of this invention. As shown in Figure 3, defibrillator 30 has a power source such as a removable battery 32, a controller such as CPU 34, and a high voltage delivery system 36 including a capacitor or capacitor bank and appropriate switches (not shown) to deliver a pulse of electrical energy to an electrode connector or interface 38 and then to a patient via electrodes 40. Delivery of the electrical pulse is controlled by CPU 34. A test and isolation relay 76 and a test load 78 are provided for reasons explained below. An ECG front end system 35 acquires and preprocesses the patient's ECG signals through electrodes 40 and sends the signals to CPU 34 via a system gate array 56. System gate array 56 is a custom application specific integrated circuit (ASIC) that integrates many of the defibrillator's functions, such as display control and many of the instrument control functions, thereby minimizing the number of parts and freeing up main CPU time for use in other tasks. The system gate array could be replaced by discrete logic and/or another CPU, of course, as known in the art. The defibrillator shown in Figure 3 also has a memory device 80 (such as a removable PCMCIA card or a magnetic tape) , a microphone 81, a speaker 82, a LCD panel 83 and a set of illuminated push-button controls 84. None of these elements is critical to the present invention. A system monitor mediates the defibrillator's self-testing functions by watching for scheduled test times and unscheduled power-on events. The system monitor generates test signals periodically at scheduled times and in response to specified events. The system monitor is also responsible for operating a fail-safe defibrillator status indicator or display. The system monitor communicates test signals to the CPU via a communication channel, and the CPU controls and gathers information from tested defibrillator components via other communication channels, some of which pass through system gate array 56. In the embodiment shown in Figure 3, system monitor 42 is separate from CPU 34 so that power can be provided to the system monitor without powering any other part of the defibrillator. Thus, system monitor 42 has its own power supply 44 apart from the defibrillator power supply 46, as shown more specifically in Figure 4. This dedicated power supply 44 draws approximately 30 microamps from battery 32 and is active whenever power is available from the battery. The dedicated system monitor power supply may also have its own battery apart from the main battery. As shown in more detail in Figure 4, the other major element of system monitor 42 is a low-power gate array 48. In this preferred implementation, gate array 48 is a 44-pin custom ASIC. Gate array 48 is preprogrammed to perform the functions of the system monitor. As an alternative, the system monitor could be implemented with a low power CPU and/or with discrete logic components. Gate array 48 operates a 32.768 kHz crystal oscillator to provide the defibrillator testing system's scheduling function. The gate array divides the oscillator's frequency repeatedly to generate periodic (e.g., daily, weekly, monthly) test initiation signals. The system monitor also sends a 32.768 kHz clock signal out on line 52 to be used by the defibrillator system to perform other functions. In addition to the periodic tests, certain defibrillator self-tests are performed rapidly in response to activation of the defibrillator's ON button (shown schematically as element 54 in Figure 4) by an operator. Activation of the ON button 54 prompts the system monitor to generate a power-on test initiation signal. The system monitor indicates the status of the defibrillator as a result of the periodic and power-on self-tests. The status indicator should be fail-safe so that the indicator will indicate an inoperable status if the system monitor should fail. The system monitor communicates control information to the status indicator through communication channels. In a preferred embodiment, the system monitor 42 powers a status indicator consisting of a visual display 58 and a piezo buzzer 60 to indicate the operational status of the defibrillator to a user. As shown in more detail in Figure 5, visual display 58 may be a multiple-part LCD 62 powered by the system monitor via AC-coupled drive 72. The top plate 64 of the LCD is a clear window with an "OK" symbol printed on its back. The middle plate 66 is an LCD shutter that is biased so as to be opaque when driven by the system monitor via drive 72. The bottom plate 68 has an international "Not" symbol on its top surface. Middle plate 66 also includes a separately addressable portion 70 driven by the system monitor via AC-coupled drive 74. In operation, the system monitor 42 drives LCD shutter 66 only when confirmation of successful testing is received within an expected time window. The visual display would then appear as in Figure 5(d) . Failure to receive proper test confirmation within the allotted time window will cause the system monitor to cease issuing drive signals to shutter 66. Shutter 66 will then go transparent to superimpose an international "Not" symbol on the "OK" symbol in the LCD as shown in Figure 5(c) . The system monitor will also then begin powering a piezoelectric failure alert buzzer 60, preferably for 200 msec, every 10 sec, so long as there is power enough to do so. The primary advantages of the visual display of the preferred embodiment are its low power requirements and the fact that it is powered by an AC signal rather than a DC signal. This latter point ensures the display's fail-safe nature, since the shutter of middle plate 66 cannot be maintained opaque without the active involvement of the system monitor generating the AC signal. Separately addressable portion 70 serves as a positive indication (in addition to the fail-safe "OK" symbol) that the defibrillator has power and is functioning properly. Portion 70 blinks periodically through the alternating driving and releasing of the signal to portion 70 through drive 74. In an alternative embodiment, an LCD shutter covering an "OK" symbol is driven open to display the "OK" symbol to indicate an operational defibrillator status. The shutter is permitted to close to cover the "OK" symbol to indicate that the defibrillator is not operational. Another alternative category of fail-safe indicators include electromechanical devices, such as those used for aircraft instrumentation. In response to the generation of a test initiation signal, the system monitor commands the defibrillator's power system to turn on. The CPU then issues an appropriate series of commands to perform the required tests. The tests performed in response to the periodic and power-on test initiation signals are described in more detail further below with reference to the table shown in Figure 6. Figure 6 shows the scheduling of some of the tests that can be performed by the self-test system of this invention. Some of the tests are performed when a battery is inserted, some are performed daily, some are performed weekly, some are performed monthly, some are performed when an operator powers-up the defibrillator, and some are performed during operation of the defibrillator. Figure 6 is not an exhaustive list of possible tests, nor is performance of any particular test listed in Figure 6 essential to the invention. The tests and test groupings shown in Figure 6 are merely an example illustrating this invention. The first test grouping is the Battery Insertion Test or BIT. The BIT tests all internal subsystems, allows the user to verify PCMCIA card type, setup parameters, and the proper operation of systems that are only externally observable (e.g., LCD operation and button functionality) . The BIT is performed whenever a good battery is inserted into the defibrillator, unless the defibrillator's electrodes are attached to a patient. The second test grouping shown in Figure 6 is the Monthly Periodic Self-Test (MPST) . The MPST performs the same automated tests as the BIT, but in order to conserve power it does not run the externally observable systems (e.g., LCD, LED's, etc.). The MPST is performed once every 28 days so long as a good battery is maintained in the defibrillator. The third test grouping shown in Figure 6 is the Weekly Periodic Self-Test (WPST) . The WPST performs essentially the same automated tests as the MPST, except the test shock is not performed in order to conserve power. The WPST is performed once every 7 days so long as a good battery is maintained in the defibrillator. The fourth test grouping shown in Figure 6 is the Daily Periodic Self-Test (DPST) . The DPST performs fewer tests than the WPST in order to conserve power. The fifth test grouping shown in Figure 6 is the Power-On Self-Test (POST) . The POST is performed whenever an operator turns the defibrillator from OFF to ON in preparation for use of the defibrillator on a patient. The tests performed in the POST are selected to provide the highest confidence of instrument functionality in the shortest possible time. The final grouping of tests in Figure 6 is the Runtime Tests. These tests are performed continually during runtime to assess the safety and effectiveness of portions of the defibrillator. The tests are explained in more detail below. The self-tests listed in Figure 6 are not necessarily listed in the order performed. The performance order depends in part on the interrelationship of the components and functions tested. To the extent there is no such relationship, then the self-test order is arbitrary. In general, failure of a self-test results in an indication of an inoperable status or error status by the defibrillator's status indicator. For example, in the defibrillator described above, failure of a self-test would result in the display of the "Not OK" symbol by the system monitor and activation of the audible failure signal. The system monitor takes this action if it receives a signal from the CPU or from the system gate array that a test has failed (i.e., that a tested component is not functional or that the component's calibration could not be verified) or if the system monitor does not receive information showing that the currently-scheduled self-test has passed before the expiration of the watchdog's time-out period (e.g., 200 msec.) . In a preferred embodiment of this invention, self-test scheduling and result information may be stored in system memory for later diagnosis of the defibrillator by a technician or operator. For example, in the defibrillator described above, date and time information regarding the self-tests performed are stored in internal memory and/or in the removable memory 80 (e.g., PCMCIA card) so that a history of performed tests can be obtained by a technician or operator. In addition, if a self-test indicates that a component or subsystem is not functional or is out of calibration, or if any recalibration has been performed, detailed information about that test is stored in internal memory and/or in removable memory. Information regarding environmental conditions (temperature, humidity, moisture, impacts) may also be stored for use in later diagnosis. The CPU self-test is a functional test. During the CPU self-test the CPU tests its internal register integrity and verifies its access to local and external memory locations. If the CPU does not pass these initial tests, it attempts to notify the user of a system failure by writing to a system failure register in the system monitor, resulting in a status display showing "Not OK" . If the CPU does ^ not respond to the system monitor within 200 msec of power on, the system monitor assumes the CPU is dead, and the "Not OK" symbol is displayed. The System Gate Array self-test is also a functional test. In the System Gate Array self-test, the CPU verifies that it can write to and read from the system gate array register set. This test also tests other components of the system gate array, such as whether defibrillator waveform control state machines are functioning correctly. Test failures are handled as for the CPU self-test above. The System Monitor Gate Array self-test is a functional test as well. The System Monitor Gate Array self-test verifies that the CPU can write to and read from the system monitor. At the beginning of the Program ROM CRC (Cyclic Redundancy Check) self-test, the CPU resets the system monitor watchdog and executes a CRC on program ROM. This test is a functional test. In the System RAM Checksum self-test (a functional test) , RAM used for data memory is verified using a test pattern that has a high probability of identifying both address and data faults within RAM. Once the pattern has been written to system RAM, the test calculates a checksum based on the system RAM contents. In the Video RAM Checksum self-test, RAM used for video memory is verified in the same manner as for the system RAM. This self-test is a functional test. In the Device Flash ROM Checksum self-test, a checksum of the voice data pointer and voice data record is calculated and compared with the checksum value stored in the internal flash ROM. This self-test is a functional test as well. In the System Watchdog Verify self-test, the CPU verifies the watchdog by writing a known watchdog time-out into the watchdog register and looping until the watchdog time-out register in the system monitor indicates that the watchdog timer has expired. During this test, the watchdog outputs, NMI, and RESET are disabled. The CPU signals a failure if the watchdog timer does not expire within the expected time frame. The PCMCIA Card Verify self-test is a functional test that checks for the presence and type of the removable memory. The next four self-tests listed in Figure 6-- Front End Gain, Artifact System, CMR Channel, and Defibrillator Connector/Relay--are all part of the ECG front end tests. These tests verify the functionality and verify the calibration of the ECG input circuitry and the patient/electrode connection circuitry. These tests are not performed during the POST since the tests assume that there is no load attached to the defibrillator output connector. An explanation of some special features of the defibrillator of this invention is required as background for the ECG front end tests. Figure 7 shows the ECG front end 35 in relationship to the system gate array 56, the high voltage delivery system 36, a test and isolation relay 76 and the patient connector 38, as well as communication channels among some of these elements. The test and isolation relay 76 is normally in the state shown in Figure 7 so that no shock can be delivered from the high voltage delivery system 36 to the patient connector 38 and to the electrodes 40 attached to a patient. In this state, any signals from electrodes 40 will pass through a pair of protective resistors 86 and 88 to an ECG amplifier 90. A high resolution A/D convertor 92 digitizes the ECG data and sends it to the system gate array 56 for processing by the CPU to determine whether a shock is required. The system gate array 56 also sends control signals to the A/D convertor 92. The ECG front end 35 also has a patient/electrode connection tester consisting of a signal generator 94 connected to the ECG signal input lines through a pair of protection resistors. The signal generator 94 receives input from the ECG analog output and carrier frequency commands from the gate array. The patient/electrode connection tester also produces an artifact test signal which is sent through ECG amplifier 90 to the CPU via line 98. ECG signal collection and analysis and artifact detection are not part of the present invention. During automated testing, the system gate array 56 uses the signal generator 94 as a test signal injector to verify the function of the various ECG front end elements, wiring to the patient connector 38, and the normally-open contacts of the test and isolation relay 76. To test the ECG processing elements, the system gate array 56 causes the signal generator 94 to inject a small, low-frequency signal mimicking the amplitude and frequency characteristics of an ECG signal, thereby simulating a patient being monitored by the defibrillator. As the frequency of this test signal is varied, the digital data stream from the system gate array is checked by the CPU for values indicative of proper gain and filtering characteristics of the ECG front end, thus verifying the functionality and calibration of the analog and A/D conversion pathways. In the Defibrillator Connector/Relay self-test, the function of the test and isolation relay contacts 100 and 102 and patient connector wiring are tested. The system gate array 56 causes the signal generator 94 to emit a 100 micrόamp, 600 Hz test signal and concurrently switches the test and isolation relay 76 to the normally- open position (shown in phantom in Figure 7) . The test current signal is carried to a 4-wire connection 104 and 106 directly on the patient connector contacts, through the relay common connection, and into the high voltage delivery subsystem 36, where both signal lines are held at ground potential. The relay 76 is then switched to its normally closed position. Carrier voltage is measured in both positions is indicative of the resistance of the circuit tested. When the relay is in normally open position, the carrier voltage should be approximately equal to the full scale voltage of signal generator 94. When the relay is in the normally closed position, carrier voltage should be approximately zero. Finally, in the Artifact System self-test, the system gate array causes the signal generator 94 to emit signals indicative of artifact generation at the electrodes. Proper receipt of artifact signals of the expected amplitude at the CPU verifies the function and calibration of this channel. There are three battery-related self-tests that are members of each of the test groupings in the preferred embodiment. The battery tests described below are based on a defibrillator design using a battery capacity indicator that applies an additional load to a single cell in the battery (called the "sense cell") . The sense cell is monitored to determine the remaining capacity of the entire battery. Other battery charge sensor arrangements and other battery charge subsystem self-tests may be used, of course, without departing from the scope of the invention. The Battery Sense Cell Measurement self-test listed in Figure 6 determines whether the remaining battery capacity is sufficient for performing one more use of the defibrillator by determining whether the voltage of the sense battery cell is above a threshold value of approximately 2 volts. If not, then a Low Battery Warning State is entered. If this state is entered during a BIT, DPST, WPST or MPST, the unit returns to Stand-by mode displaying the "Not OK" symbol. If this state is entered during a POST or during runtime, the user is alerted by a symbol appearing on the LCD display 83 and with an audible prompt. The second listed battery self-test is the Battery Sense Cell Load Check. This calibration verification self-test verifies the sense cell additional load circuitry by turning the additional load circuitry on and off and measuring the voltage load across the load resistor. This test can actually be performed while performing the first battery self-test. The third listed battery self-test is the Battery Stack Check. This functional test measures the voltage of the entire battery cell stack as a cross-check against the Battery Sense Cell Measurement test. If a portion of the battery stack other than the sense cell has been damaged, the voltage of the entire stack could be different than that which would have been expected based on the sense cell test. In the Power Supplies Check calibration verification self-test, the system monitor activates the defibrillator's power supply system to supply power to all of the instrument's elements. Scaled representations of the voltages from the supplies are input for verification to the main CPU A/D convertor. For example, the major power supplies are: +18 volt switched battery; +5 volt for system monitor; +5 volts for main logic and analog; -5 volt for analog only; -14 to -22 volt CPU adjustable for LCD bias; +20 volts for IGBT switch drives; +2.5 volt reference for ECG front end; +5 volt reference for main CPU A/D convertor; and 50 ma current source supply for LCD backlight (tested by voltage developed) . In addition, the high voltage supply is tested by its ability to charge the capacitor. The HV Isolation Relay self-test determines the functionality of the test and isolation relay 76. In the first part of the test, the system gate array 56 moves the test and isolation relay to its normally open position, i.e., with the switches against contacts 100 and 102. The ECG front end measures the impedance across conductors 96 and 97. If the measured impedance corresponds to a predetermined impedance value, then the relay passes this part of the test. The ECG front end then measures the impedance across conductors 96 and 97 with the test and isolation relay 76 in the normally closed position shown in Figure 7. The measured impedance should be high (>14k Ohms) . If not, either a load is present at electrodes 40 or the relay failed to move completely to the normally closed position. In either case, the test fails, and the system monitor displays the "Not OK" symbol on the status indicator. In addition, failure to meet both parts of the Isolation Relay test prevents the defibrillator from performing the High Voltage Discharge Test described below. Under normal conditions, the defibrillator used to implement and practice the preferred embodiment of this invention delivers a truncated exponential biphasic waveform to the patient. Figure 8 provides further information regarding the preferred defibrillator's high voltage delivery system and how its operation is verified and calibrated during self-test. High voltage delivery system 36 has a capacitor or capacitor bank 112 which can be charged to a preset voltage through a high voltage charger 114 connected to the power supply system 46 and battery 32. Operation of the high voltage charger is controlled by system gate array 56. A high voltage switch 110 consisting of five switches A-E and a shunt resistor contr °l s delivery of the biphasic waveform from capacitor 112 to the patient connector 38 through test and isolation relay 76 under the control of system gate array 56. Information regarding charge, current and voltage parameters at the capacitor is provided to system gate array 56 by a current and charge measurement device 116, an overvoltage detector 118 and a voltage divider 120. Current and charge measurement device 116 is preferably a comparator that trips when a preset charge amount has been transferred from capacitor 112. The time required for this charge transfer is determined by system gate array 56 and is used to determine first and second phase durations via a look-up table in system gate array 56. All information and control signals pass among the elements via communication channels, some of which are shown schematically in Figure 8. Resistor jj pg -- s P rt of an overcurrent protection mechanism to protect circuit components from the effects of high current in the event that the impedance load between electrodes 40 is too low. Unless the initial current as measured by current and charge measurement device 116 is below a preset threshold, is kept in the waveform delivery circuit to limit the current flowing from capacitor 112 through the switching mechanism 110. The high voltage delivery system has an overvoltage protector that protects switching circuit components from the effects of excessive voltage in the event of a higher than expected patient load resistance by preventing any transition from a first biphasic waveform phase to a second biphasic waveform phase. Analog voltage information from the capacitor is fed from a voltage divider 122 to an overvoltage detector 118. Overvoltage detector 118 is preferably a comparator that trips at a preset voltage. The status of the comparator is communicated to system gate array 56, which controls operation of the switching mechanism 110. Finally, analog information regarding the charge state of capacitor 112 is sent to CPU 34 via voltage divider 120, where it is converted to digital form. This capacitor voltage information is used by the CPU to control capacitor charging. The High Voltage Delivery Subsystem self-test actually includes a number of individual self-tests. Capacitor 112 is charged to full voltage (e.g., approx. 1710 volts) . As the capacitor voltage rises, the calibration of the overvoltage detector 118 is checked to see that it trips at the proper threshold voltage. If it fails to trip, the system gate array returns a signal to the system monitor to show "Not OK" on the status indicator. After the capacitor has been fully charged, the system gate array 56 sets the high voltage switch 110 to its normal initial discharge position (switches A and E closed, all other switches open) and commences discharge of the capacitor through the test and isolation relay 76 to the test load resistance R L . R L simulates the load of a patient to whom the defibrillators electrodes may be attached. R L is preferably approximately 10 ohms, however, which is smaller than the minimum allowable patient resistance for the defibrillator. This low resistance assures that the test stresses all of the elements tested in the high current pathways for worst- case patient conditions. During this part of the High Voltage Delivery self-test, the system gate array verifies overcurrent detection calibration by determining whether the CPU correctly identifies the overcurrent condition detected by current and charge measurement device 116. The system gate array also checks for proper operation of the charge threshold detector and that the overvoltage detector 118 trips properly when the capacitor voltage drops below the safe voltage threshold, in both cases by determining whether these events occur at their expected times. If either of these parameters is not its expected value, the system monitor displays "Not OK" on the status indicator. -As the capacitor voltage drops during discharge through the test load, the current measured by the current and charge measurement device 116 drops as well. The CPU marks the time the current drops below the overcurrent threshold (t Q ) . As the current continues to fall, the CPU marks the time (t-_) that the current reaches a value that is 37% of the overcurrent threshold. The difference of these two times is the time constant given by the product of the capacitor value C and the series resistance: t l ' t 0 ~ ( R L + R BITE * c ' Switch D is then closed to short out RBJTE- This results in another overcurrent situation, and the CPU once again marks the time (t 2 ) of capacitor decay to the overcurrent threshold and the time (t 3 ) to 37% of the threshold. Since has been removed, fc 3 " fc 2 = R L * '- • Since the time measurements can be made very accurately, the relationships between the resistive and capacitive components (and therefore their calibration) can be verified very accurately as well: ^1~^0 _ R *RBJ_TE t 3 ~t 2 t,~t, C=— - If the calculated resistance value differs from the expected value by more than a predetermined amount (e.g., 1%) , or if the calculated capacitance value differs from the expected value by more than a predetermined amount (e.g., 5%), the system monitor displays the "Not OK" symbol. In the preferred embodiment, the gain of the comparators of the current and charge measurement subsystems are determined by the particular values of the components used during assembly of the device. Due to allowable tolerance variation of the components, the times that the currents pass associated threshold values (t Q and t 2 ) may vary from ideal values (t Q (ideal) and t 2 (ideal)). Actual values of t Q and 2 are measured during self-test of the instrument and compared to stored t 0 (ideal) and t 2 (ideal). If the actual values of t Q and t 2 measured during the High Voltage Discharge Test differ from the ideal values by less than a preset amount, then the gain on the comparator of the current and charge measurement device 116 is automatically recalibrated by the CPU to a range closer to the ideal value. If the actual values differ from the ideal by the preset amount or more, the test fails and the system monitor displays the "Not OK" symbol on the status indicator. In a similar manner, the expected time for times for the measured charge delivery to cross the charge threshold used to determine first and second phase durations in normal operation is compared to the actual time. If the difference is less than a preset value, the CPU recalibrates the phase durations by recalculating the phase duration values according to a predetermined equation and storing the new values in the look-up table. Alternatively, the CPU could simply replace the original look-up table with another that is correlated with a particular time difference. If the time difference is equal to or greater than the preset value, then the test fails and the system monitor displays the "Not OK" symbol on the status indicator. Another feature of the defibrillator of preferred embodiment is an undercurrent detector. If the patient to whom the electrodes are attached has an impedance greater than a specified value, or if one of the electrodes has become dislodged or unattached, in normal operation the defibrillator's discharge will abort. This condition is detected by the current and charge measurement device 116 in conjunction with the CPU. The High Voltage Delivery self-test verifies calibration of the undercurrent detector by determining whether the low current condition is detected as the capacitor continues its discharge and the discharge current falls. If the CPU fails to detect the undercurrent condition, the test fails and the system monitor displays the "Not OK" symbol on the status indicator. After the capacitor has completely discharged, it is recharged and discharged through the second current path by opening all switches in high voltage switch 110, then closing switches B and C. Many of the same parameters described above can be measured to verify the functionality of switches B and C. The Waveform Delivery self-test is performed only while the defibrillator is operating in normal mode (e.g., connected to a patient). The defibrillator evaluates the measured and calculated waveform parameters after each delivered shock to determine if the waveform was delivered as expected. For example, if the defibrillator is constructed and operated to deliver a truncated " exponential biphasic waveform, the defibrillator will analyze waveform parameters such as start voltage, phase 2 end voltage, phase 1 duration and phase 2 duration. If the delivered waveform parameters cannot be reconciled with other information available to the defibrillator, the defibrillator warns the operator of a potential fault condition by, e.g., displaying a warning on the defibrillator's LCD. The three Calibration Standard self-tests are an automatic way of verifying that defibrillator system standards have not drifted out of calibration. The standards are the values of R L , R jj pE' the s Y stem monitor clock, the CPU clock, the CPU A/D convertor reference voltage and the ECG front end A/D convertor reference voltage. For all test groupings except the run time test, the voltage references are checked against each other to determine if either has drifted far enough from its expected value to affect the accuracy of the defibrillator. Specifically, the analog reference voltage for the ECG front end A/D convertor (which has an expected value of 2.5 volts in the preferred embodiment) is measured by the CPU A/D convertor. If the measured digital value differs from 2.5 volts by more than a predetermined tolerance, then at least one of the two reference voltages (i.e., either the ECG front end A/D convertor reference voltage or the CPU A/D convertor reference voltage) has drifted so far so as to affect the reliability of the device. The time references are cross-checked in a similar way. The CPU counts the clock pulses from the system monitor clock for a predetermined amount of time (as measured by the CPU clock) . If the number of counted system monitor clock pulses differs from its expected value by more than a predetermined amount, then at least one of the two clocks has drifted out of the tolerance range. In addition, as discussed above, the High Voltage Delivery self-test cross-checks the values of R L and BITE* Verification of the calibration of all three sets of reference variables is a prerequisite to the overcurrent detection calibration and charge threshold detection calibration described above. In normal stand-by mode, the contacts beneath all buttons should be open. The Stuck Button self-test determines whether any of the contacts are closed. If so, the test returns a "Not OK" signal. The remaining tests require user intervention and/or observation and are therefore part of only the BIT or POST test groupings. In the Button test, the user is prompted to depress identified buttons on the instrument to determine whether the buttons are functioning properly. All of the other tests run without user intervention. They each require the user to observe that the defibrillator elements tested are functioning correctly. In addition to performing the self-tests according to the periodic schedule and in response to the battery insertion and operation of the defibrillator (as shown in Figure 6) , a group of self-tests can be performed automatically in response to environmental events, such as. mechanical shock, e.g. as in a fall (as measured by an accelerometer) ; vibration (also as measured by an accelerometer) ; the invasion of moisture into the defibrillator housing (as measured by a humidity sensor) ; or exposure of the defibrillator to temperature extremes (as measured by a thermocouple, thermistor or other temperature sensor) . An alternative embodiment of this invention is shown in Figure 9. Unlike the preferred embodiment discussed above which tests the entire defibrillator up to but not including the defibrillator electrodes, the self-test system of this first alternative embodiment checks the integrity of electrodes stored with the defibrillator. This alternative embodiment may be used together with the self-test system described above in the preferred embodiment, although it may also be used with other defibrillator self-tests systems and methods. In Figure 9, an electrode apparatus 202 includes a pair of electrodes 204, conductive gel layers 206 covering the electrodes, and a pair of test pads or contacts 208 shown here to be in electrical contact with gel layers 206. Electrodes 204 connect to a standard defibrillator circuit via conductors 210. In the circuit state shown here, the system is set to monitor patient ECG signals as if the electrodes were attached to a patient. In this monitoring state, switches 212 send the incoming signal from the electrodes through a preamp 214 and an A/D converter 216 for preprocessing before forwarding the signal to system microprocessor 218. Microprocessor 218 monitors the received ECG signals and compares them to stored patterns or other criteria to distinguish normal patient ECG patterns from ECG patterns requiring action by the defibrillator system, as discussed below. When configured as shown in Figure 9, i.e., so that electrodes- 204 are in electrical contact with test pads 208, the system is in test mode. The defibrillator system of this invention has a patient simulation and test circuit 220 to monitor the condition and integrity of the system prior to deployment of the electrodes and application of the electrodes to a patient. Periodically, microprocessor 218 sends a series of test signals to D/A converter 222, which converts the signals to their analog equivalent and transmits the signals to test pads 208 via conductors 224. Electrodes 204 retrieve the test signals as if the test signals were actual patient ECG signals and sends the signals back to the microprocessor through the ECG monitor circuit described above. Preferably, the test signals are of at least two types: normal patient ECG waveforms, and ECG waveforms indicating a therapeutic pulse is required. The microprocessor analyzes the test signals as if they were actual patient ECG signals and decides whether or not to apply a therapeutic pulse to the electrodes. In ECG test mode, however, the actual pulse is not generated or applied. Rather, the microprocessor examines its own decision to determine if it was correct. If the outgoing ECG test signal from the microprocessor to the D/A converter was a normal ECG waveform and the microprocessor determines from the incoming test ECG signal that a therapeutic pulse is required, the system is faulty, and the microprocessor indicates the fault on a fault indicator or status indicator 226. Likewise, if the outgoing ECG test signal from the microprocessor to the D/A converter was an ECG waveform indicating the need for a therapeutic pulse and the microprocessor determines from the incoming test ECG signal that a therapeutic pulse is not required, the system is faulty, and the microprocessor indicates the fault on a fault indicator or status indicator 226. If, on the other hand, the microprocessor determines correctly the required course of action, the status indicator is not activated. If the system passes the ECG tests, it then performs a defibrillator test by generating a pulse through its normal pulse generating circuitry and sending the pulse to the electrodes 204. To initiate the pulse test, the microprocessor sends a charge command to a charge controller 230, which begins charging capacitor 232 in a known manner from power supply 234. When the charge on capacitor 232 has reached the required level (either the charge level required for normal operation or some other test charge level) , switch relay 228 moves switches 212 to their other position. This switch position permits the pulse circuit to discharge the capacitor to deliver a damped sinusoidal shock to the electrodes. The pulse transmitted by the electrodes through conductive gel layers 206 to test pads 208 is monitored by the test circuit 220 across a patient load simulator 236. The signal is reduced by a divider circuit and sent to microprocessor 218 via A/D converter 238. If the pulse received by the microprocessor does not meet predetermined criteria (such as voltage levels and signal wavefor shape) , the microprocessor indicates a system fault by activating status indicator 226. So long as the system passes the tests, the tests are repeated periodically until the electrodes and their gel layers are removed from test pads 208 as determined by a deployment detector 240. Figures 10 and 11 show a particular electrode apparatus that can be used to practice the self-test invention of the first alternative embodiment, and Figures 12-14 show the electrodes of Figures 10 and 11 mounted in a retainer for use with a defibrillator. Other electrode'and retainer designs may also be used, of course, without departing from the invention. As shown in Figures 10 and 11, the electrode apparatus 340 has a relatively stiff electrode body 345 attached to a flexible substrate 342 with a medical grade adhesive. In this embodiment, substrate 342 is a polymer such as polyester or Kapton, approximately 3 mils thick. The length of substrate 342 depends on the requirements of the application. Electrode body 345 is preferably made from a light-weight, closed-cell foam approximately 25 mils thick. An electrode disk 344 is disposed within electrode body 345. Electrode disk 344 is preferably a circular piece of metal foil, such as 3 mil tin, approximately 80 cm 2 in area, attached to substrate 342 with a suitable medical grade adhesive. Electrode disk 344 is covered with a layer of conductive gel 351 in a known manner. The thickness of gel layer 351 is 25 mils to make its top surface approximately even with the surrounding electrode body surface. Medical grade adhesive is disposed in adhesive area 352 on the top surface of electrode body 345 surrounding the opening 353 for electrode disk 344. A first conductor 346 and a first electrical attachment pad 348 are formed on, or attached to, flexible substrate 342. Conductor 346 and electrical attachment pad 348 are preferably 3 mil tin foil formed integrally with electrode disk 344 and attached to substrate 342 with adhesive. A second conductor 343, a second electrical attachment pad 341 and a test pad 338 are formed on, or attached to, substrate 342. Conductor 343, attachment pad 341 and test pad 338 are also preferably formed as an integral piece of metal foil attached to substrate 342 with adhesive. An insulating cover 347 is adhesively attached over substrate 342 and conductors 343 and 346. Cover 347 has a silicon release coating on its top side. Openings 349 and 337 are formed in cover 347 so that attachment pads 348 and 341, respectively, can make electrical contact with a connector, as described below. An additional opening 339 is formed in cover 347 so that test pad can make electrical contact with electrode 344 through gel 351, also as described below. In Figures 12-14, a pair of the electrodes shown in Figures 10 and 11 are mounted in a retainer for use with a defibrillator system. Figure 12 shows the electrodes in a predeployment storage position. In this position, the flexible substrate 342 of each electrode is folded in an accordion fashion and placed in retainer 360. The portion of substrate 342 on which the attachment pads 341 and 348 are located extends into a retainer connector area 370 for electrical attachment to a corresponding connector 372 on the defibrillator 358. Figure 13 shows the details of one embodiment of the connectors for attachment pads 348 on the two electrode apparatuses. The same arrangement may be used for attachment pads 341. Metal crimps 374 at the end of substrate 342 make electrical contact with attachment pads 341 and 348. The crimps 374 partially extend through openings 378 in the connector portion 370 of retainer 360. When the retainer connector portion is inserted into the connector portion of the defibrillator 358, crimps 374 make electrical contact with defibrillator contacts 376. The resilient action of the crimps 374 also provide the mechanical attachment of retainer 360 to defibrillator 358. The contacts 376 for each electrode and for each test pad are connected to the defibrillator electronics in a known manner. The test pads 338, their associated conductors 343, their attachment pads 341, and the retainer connector 370 serve as the interface between the electrodes and a patient simulator circuit within defibrillator 358 during the defibrillator system tests described above. A status indicator 359 such as a light or an audible annunciator is provided to inform the user of test results. Likewise, the conductors 346 and attachment pads 348 " on the substrates are the interface between the electrodes and the defibrillator for delivery of the defibrillating voltage pulse and/or for monitoring of the electrical activity of the patient's heart during normal operation of the defibrillator. The positions of the electrode apparatus during the two operational modes will be explained with reference to Figures 12 and 14. In the folded position shown in Figure 12, the conductive gel 351 covering the electrode disk 344 of each electrode apparatus lies in electrical contact with its respective test pad 338. This contact closes the circuit going from one electrode through the patient simulation circuit to the other electrode so that the patient simulation tests can be performed. Also, in the folded position shown in Figure 12, the adhesive surrounding the electrode disk lies against an area 354 on the top surface of substrate 342. The top surface of substrate 342 is coated with a suitable release coating such as silicon in at least release area 354. The release coating enables the adhesive to peel away from substrate 342 during deployment of the electrode, as discussed below. The covering action of the substrate over the conductive get also helps keep the conductive gel from drying out during storage. A handle 356 attached to the back side of electrode body 345 lies in position in which it can be grasped by a user during deployment of the electrodes. Figure 14 demonstrates deployment of the electrodes. As shown in Figure 14, the user pulls electrode body 345 out of retainer 360 by grasping handle 356. As it moves out of the retainer, the electrode disk 344 and its conductive gel layer 351 peel away from substrate surface 342. Movement of the conductive gel layers 351 of the electrodes away from their respective test pads 338 breaks the circuit through the patient simulator. After removal from the retainer, the electrodes may be place on a patient and used for monitoring the patient's heart activity and for applying therapeutic electrical pulses in the usual manner. Figures 15-18 show a second electrode and retainer design that can be used to practice the self- test invention of the first alternative embodiment of this invention. As shown in Figures 15 and 16, the electrode apparatus 140 has a flexible body or substrate 142, preferably formed from 1/16" closed cell foam. A backing layer 182 is attached to the underside of substrate 142 with a medical grade adhesive. Backing layer 182 may be formed from Tyvek or any other suitable material. The underside of backing layer 182 is coated with a silicon release material. A pair of test pads 138 are adhesively attached to the top of backing layer 182 over a pair of openings 184 whose diameters are slightly smaller than the diameters of test pads 182. Openings 184 provide access to test pads 138 from the underside of backing layer 182. Conductors 142 lead from test pads 138 to attachment pads 141. Openings 186 beneath attachment pads 141 have diameters slightly smaller than the diameters of attachment pads 141. Each set of test pad, conductor and attachment pad is preferably formed from a single piece of tin metal foil 3 mils thick. A pair of electrodes 144 are adhesively attached to the top of substrate 142. Conductors 146 lead from electrodes 144 to attachment pads 148. Each set of electrode, conductor and attachment pad is preferably formed from a single piece of tin metal foil 3 mils thick. The surface area of each electrode is preferably 80 cm 2 . A layer of conductive gel 151 covers each electrode. The thickness of the conductive gel layer is preferably 25 mils. An insulating cover 147 is attached to the top side of substrate 142 with medical grade adhesive. Cover 147 has openings 180 for the electrodes and openings 149 for the attachment pads. Openings 180 have diameters slightly smaller than the diameters of their respective electrodes, and openings 149 have diameters slightly smaller than their respective attachment pads. Medical grade adhesive covers all of the top surface of cover 147 except for handle area 156 and connector area 157 for attachment of the electrode apparatus to a patient. Figures 17 and 18 show the electrode apparatus of this embodiment mounted in a retainer. As seen in Figure 17, prior to deployment, the electrode apparatus is wound around a spool-shaped retainer 160 mounted on top of a defibrillator 158. The portion of the electrode apparatus on which the attachment pads 141 and 148 are located extend into the center of the retainer spool where they make electrical connection with conductors (not shown) that connect to the defibrillator connector 172. The metal crimps shown in Figure 13 may be used for this purpose. A protective cover 164 may be kept over retainer spool 160 until the electrodes are to be deployed. In the undeployed state shown in Figure 17, the conductive gel layers 151 and the adhesive coating on cover layer 147 face the inward toward the center of the retainer spool, and the release coating on the underside of backing layer 182 faces outward from the center. Thus, when the electrode apparatus is wound about itself, the conductive gel layers 151 and the adhesive coating on the cover layer lie against the silicon release coating of the backing layer 182. Also, the conductive gel layers 151 of each electrode lie in electrical contact against their respective test pads 138, as shown. This contact closes the circuit going from one electrode through the patient simulation circuit to the other electrode so that the patient simulation tests can be performed. A status indicator 159 such as a light or an audible annunciator is provided to inform the user of test results. To deploy the electrode apparatus of this embodiment, the protective cover 164 is removed, and the electrode apparatus is unwound from retainer spool 160 by pulling on handle or tab 156, as shown in Figure 18. The release coating on backing layer 182 permits the conductive gel layers 151 and the adhesive on cover layer 147 to peel away. Movement of the conductive gel layers 151 of the electrodes away from their respective test pads 138 breaks the circuit through the patient simulator. The electrode apparatus is then applied to the patient and used for monitoring the patient's heart activity and for applying therapeutic electrical pulses in the usual manner. The electrode apparatus and spool retainer remain attached to the defibrillator during use. The conductors 146 and attachment pads 148 provide the electrical connection between the electrodes 144 and the defibrillator for delivery of the defibrillating voltage pulse and/or for monitoring of the electrical activity of the patient's heart. After use, the retainer spool and the electrode apparatus it houses can be discarded and replaced with a new electrode set. Variations of the structure and methods described above are within the scope of this invention. Tests and test structures may be tailored to meet the needs of a particular defibrillator design and its intended use environment.

Claims: What is claimed is: 1. A defibrillator comprising: a high voltage delivery system comprising an energy source and a switch connecting the energy source to the exterior of the defibrillator; a controller operably connected to the high voltage delivery system; and a self-test system comprising a defibrillator status indicator and a test signal generator. 2. The defibrillator of claim 1 wherein the self-test system further comprises a functionality tester and communication channels between the functionality tester and the test signal generator and between the functionality tester and the status indicator. 3. The defibrillator of claim 2 wherein the high voltage delivery system further comprises a switch, the self-test system further comprising a communication channel between the functionality tester and the switch. 4. The defibrillator of claim 2 wherein the self-test system further comprising a communication channel between the functionality tester and the controller. 5. The defibrillator of claim 2 wherein the self-test system further comprises a relay having an operational position and a test position, the self-test system further comprising a communication channel between the functionality tester and the relay. 6. The defibrillator of claim 2 further comprising an electrode, the self-test system further comprising a communication channel between the functionality tester and the electrode. 7. The defibrillator of claim l wherein the self-test system further comprises a calibration verifier and communication channels between the calibration verifier and the test signal generator and between the calibration verifier and the status indicator. 8. The defibrillator of claim 7 further comprising an overcurrent detector, the self-test system further comprising a communication channel between the calibration verifier and the overcurrent detector. 9. The defibrillator of claim 7 further comprising an undercurrent detector, the self-test system further comprising a communication channel between the calibration verifier and the undercurrent detector. 10. The defibrillator of claim 7 further comprising an overvoltage detector, the self-test system further comprising a communication channel between the calibration verifier and the overvoltage detector. 11. The defibrillator of claim 7 further comprising an ECG front end, the self-test system further comprising a communication channel between the calibration verifier and the ECG front end. 12. The defibrillator of claim 7 wherein the high voltage delivery system comprises a resistor, the self-test system further comprising a communication channel between the calibration verifier and the resistor. 13. The defibrillator of claim 12 wherein the high voltage delivery system resistor is a reference standard for the defibrillator. 14. The defibrillator of claim 13 further comprising a second resistor, wherein the high voltage delivery system resistor and the second resistor together are reference standards for the defibrillator. 15. The defibrillator of claim 7 wherein the high voltage delivery system comprises a capacitor, the self-test system further comprising a communication channel between the calibration verifier and the capacitor. 16. The defibrillator of claim 7 wherein the controller comprises a clock, the self-test system further comprising a communication channel between the calibration verifier and the clock. 17. The defibrillator of claim 16 wherein the controller clock is a reference standard for the defibrillator. 18. The defibrillator of claim 17 further comprising a second clock, wherein the controller clock and the second clock together are reference standards for the defibrillator. 19. The defibrillator of claim 7 further comprising a voltage source, the self-test system further comprising a communication channel between the calibration verifier and the voltage source. 20. The defibrillator of claim 19 wherein the voltage source is a reference standard for the defibrillator. 21. The defibrillator of claim 20 further comprising a second voltage source, wherein the first and second voltage sources together are reference standards for the defibrillator. 22. The defibrillator of claim 1 wherein the self-test system further comprises a recalibrator. 23. The defibrillator of claim 22 further comprising a current sensor, the self-test system further comprising a communication channel between the recalibrator and the current sensor. 24. The defibrillator of claim 22 further comprising a waveform shape controller, the self-test system further comprising a communication channel between the recalibrator and the waveform shape controller. 25. The defibrillator of claim 1 further comprising a battery, the self-test system further comprising a battery condition tester and communication channels between the battery condition tester and the battery, between the battery condition tester and the status indicator, and between the battery condition tester and the test signal generator. 26. The defibrillator of claim 1 wherein the test signal generator comprises a system monitor that is separate from the controller. 27. The defibrillator of claim 26 wherein the system monitor comprises an ASIC. 28. The defibrillator of claim 26 further comprising a controller power supply, wherein the system monitor comprises a system monitor power supply separate from the controller power supply. 29. The defibrillator of claim 26 wherein the system monitor further comprises means for generating periodic test signals. 30. The defibrillator of claim 26 wherein the system monitor further comprises means for generating test signals in response to specified events or conditions. 31. The defibrillator of claim 30 in which the event or condition is a power-on request from an operator for use of the defibrillator. 32. The defibrillator of claim 30 in which the event or condition is the insertion of a battery into the defibrillator. 33. The defibrillator of claim 30 in which the event or condition is environmental. 34. The defibrillator of claim 33 in which the environmental event or condition is temperature. 35. The defibrillator of claim 33 in which the environmental event or condition is moisture. 36. The defibrillator of claim 33 in which the environmental event or condition is mechanical shock. 37. The defibrillator of claim 33 in which the environmental event or condition is vibration. 38. The defibrillator of claim 26 wherein the system monitor comprises a watchdog timer. 39. The defibrillator of claim 1 wherein the status indicator comprises a visual display. 40. The defibrillator of claim 39 in which the visual display comprises means for providing fail-safe operation. 41. The defibrillator of claim 1 wherein the status indicator comprises a sound generator. 42. The defibrillator of claim 1 further comprising memory and a communication channel between the self-test system and the memory. 43. A method for automatically determining and indicating the operational status of a defibrillator, the method comprising the following steps: generating a test signal within the defibrillator automatically in response to a predetermined event or condition; performing a self-test in response to the test signal; and indicating the status of the defibrillator based on a result of a self-test. 44. The method of claim 43 wherein the event or condition is the passage of time. 45. The method of claim 43 wherein the event or condition is an operator's request for use of the defibrillator. 46. The method of claim 43 wherein the event or condition is insertion of a battery into the defibrillator. 47. The defibrillator of claim 43 in which the event or condition is environmental. 48. The defibrillator of claim 47 in which the environmental event or condition is temperature. 49. The defibrillator of claim 47 in which the environmental event or condition is moisture. 50. The defibrillator of claim 47 in which the environmental event or condition is mechanical shock. 51. The defibrillator of claim 47 in which the environmental event or condition is vibration. 52. The method of claim 43 wherein the self- test determines the functionality of a defibrillator component or system. 53. The method of claim 43 wherein the self- test verifies the calibration of a defibrillator component or system. 54. The method of claim 53 further comprising the step of recalibrating a defibrillator component or system in response to a calibration verification self- test. 55. The method of claim 53 wherein the self- test comprises discharging a capacitor and measuring electrical and time values associated with the capacitor's discharge. 56. The method of claim 53 wherein the self- test further comprises using a resistance within the defibrillator as a reference value. 57. The method of claim 53 wherein the self- test further comprises using two resistances within the defibrillator as reference values through a comparison of two resistance values. 58. The method of claim 53 wherein the self- test further comprises using a voltage source within the defibrillator as a reference value. 59. The method of claim 53 wherein the self- test further comprises using two voltage sources within the defibrillator as reference values through a comparison of two voltage source values. 60. The method of claim 53 wherein the self- test further comprises using a clock within the defibrillator as a reference value. 61. The method of claim 53 wherein the self- test further comprises using two clocks within the defibrillator as reference values through a comparison of two clocks. 62. The method of claim 43 wherein the indicating step comprises displaying status information on a visual display. 63. The method of claim 62 wherein the displaying step comprises providing an active display signal to the visual display, the visual display having a first state when provided with the active display signal and a second state in the absence of the active display signal, the second state indicating a nonoperational state of the defibrillator. 64. The method of claim 63 wherein the active display signal is an AC signal. 65. The method of claim 43 wherein the indicating step comprises providing audible status information. 66. A method for testing and indicating the operational status of a defibrillator comprising the following steps: generating a test signal within the defibrillator automatically and periodically on a predetermined schedule; performing a plurality of self-tests in response to the test signal to determine the status of a plurality of components of the defibrillator, the tests being performed without human intervention; and indicating the status of the defibrillator in response to at least one of the self-tests. 67. The method of claim 66 further comprising the step of generating a test signal within the defibrillator automatically in response to a predetermined event. 68. The method of claim 67 further comprising the step of generating a test signal within the defibrillator automatically in response to an environmental condition or event. 69. The method of claim 66 wherein at least one of the self-tests determines the functionality of a defibrillator component or system. 70. The method of claim 69 wherein at least one of the self-tests verifies the calibration of a defibrillator component or system. 71. The method of claim 70 further comprising the step of automatically recalibrating a defibrillator component or system in response to a self-test. 72. A medical electrode instrument system comprising: an electrode; an instrument for sending electrical signals to, or receiving electrical signals from, the electrode; and an electrical interface between the electrode and the instrument; the instrument having a self-test system comprising a test signal source selectively connectable to the electrode through the electrode interface and an analyzer to detect a received signal across the electrode and to determine a condition of the medical electrode system from the received signal. 73. The medical electrode instrument system of claim 72 further comprising a second electrode, the electrical interface being between the second electrode and the instrument, the test signal source being selectively connectable to the second electrode through the electrode interface, the analyzer detecting the received signal across the first and second electrodes. 74. The medical electrode instrument system of claim 73 wherein the self-test system further comprises a patient simulation circuit electrically connected to the electrode interface to receive the received signal and to transmit the received signal to the analyzer. 75. The medical electrode instrument system of claim 73 further comprising a status indicator in communication with the analyzer to indicate a condition of the medical electrode system. 76. The medical electrode instrument system of claim 73 wherein the electrode interface comprises a first conductor electrically connected to the first electrode and the instrument; conductive gel applied to the first electrode; a second conductor selectively electrically connected to the first electrode conductive gel and the instrument; a third conductor electrically connected to the second electrode and the instrument; conductive gel applied to the second electrode; a fourth conductor selectively electrically connected to the second electrode conductive gel and the instrument. 77. The medical electrode instrument system of claim 76 further comprising a flexible substrate supporting the first, second, third and fourth conductors. 78. The medical electrode instrument system of claim 73 wherein the test signal source comprises a source of a simulated ECG signal. 79. A medical electrode system for use with a self-testing defibrillator comprising an electrode and an electrode interface for selectively connecting the electrode to an instrument, the electrode interface comprising a first conductor electrically connected to the electrode; conductive gel applied to the first electrode; a second conductor selectively electrically connected to the conductive gel; and a connector providing selective electrical connection between the first and second conductors and an instrument. 80. The medical electrode system of claim 79 further comprising a flexible substrate supporting the electrode and the first and second conductors. 81. The medical electrode system of claim 79 further comprising a second electrode and a second electrode-interface, the second electrode interface comprising a first conductor electrically connected to the electrode; conductive gel applied to the second electrode; a second conductor selectively electrically connected to the conductive gel; and a connector providing selective electrical connection between the first and second conductors and an instrument. 82. The medical electrode system of claim 81 further comprising a flexible substrate supporting the first and second electrodes, the first and second conductors of the first electrode, and the first and second conductors of the second electrode.

Inventors: CAMERON DAVID, COLE CLINTON, LYSTER THOMAS, MORGAN CARLTON, MYDYNSKI STEVEN T, POWERS DANIEL, CAMERON, DAVID, COLE, CLINTON, LYSTER, THOMAS, MORGAN, CARLTON, MYDYNSKI, STEVEN, T., POWERS, DANIEL
Applicants: HEARTSTREAM INC, HEARTSTREAM, INC.
Application year: 1994
Main classification: A61N1
IPC codes: A61N1